Indexing Title: JPingul’s Medical Anecdotal Report 06-03

Date of Medical Observation: March 6, 2006

Title: Doctor-patient relationship 

Narration: 

I never imagined that I would narrate this kind of anecdote during my residency training but I would.   

It was one of the usual duty nights, when the patient, who was working as a government employee on duty, noted that he had vague epigastric pain.  He narrated that they were about to eat dinner when he felt the pain, he also noted that he lost his appetite and was nauseated. 

He excused himself from the rest of his office mates who were on duty and tried to relieve the epigastric pain by lying down on his stomach, he also tried defacating, but to no avail, the pain persisted.  Then he got an emergency call, from his staff and informed him that there was an operation to be conducted.  He got up and joined the operation until it was completed, still with the pain, but with little complaints.  It was already dawn when he returned to bed and fell asleep.  After a few hours, he was awakened by severe pain on the right lower quadrant of the abdomen, and the epigastric pain was gone.  At this time, his diagnosis was acute appendicitis, based on history, it was a classic one. 

But how can the patient consult the doctor, and a doctor treat the patient, when the doctor and the patient are the same person.  The patient was me.  Can I possibly make an objective physical examination upon myself?  I tried to palpate my abdomen and tried to elicit for signs of peritonitis, but my mind forced my fingers to tell myself that it was non-tender.  So I asked for help. 

I called my junior and referred my case and asked him to come over and do physical examination on me.  He did and his diagnosis was acute appendicitis, early onset.  I started thinking about treatment options, between open or laparoscopic.  I also started thinking about where I would be confined and be operated on.  All my knowledge of benefit, risk, cost, and availability was wasted because I chose which was most costly.  I was irrational.  I was even in denial.  I would do anything in my power to by-pass an operation.  I even started loading myself with antibiotics, which was way off protocol.  Bottom line was, I did not want an operation on myself, I did not want post-operative adhesions, I did not want any of the things that I inflict upon my patients. 

Wow, I was such a stubborn patient.                                                                              

INSIGHTS: (DISCOVERY, stimulus, reinforcement), (physical, psychosocial, ETHICAL) 

I have narrated anecdotes about difficult patients in the past, I am fully aware how irritating they can become, but I never realized that I would be like them when it involved myself. 

Looking back, I did not want to be irrational or stubborn or to be in a state of panic, but during that time I was.  I tried to hide my fear, but I was really afraid.  I was afraid because I experienced seeing healthy patients die on the OR table, or because of the thought of regional anesthesia, and the thought of putting my trust on the very people I have doubted. 

During that I time, everything was ironic.  The doctor is the patient.  How can I transcend my identity from a healer to the one who is sick?  How can I put my trust on the hands of doctors, knowing fully well that doctors make mistakes, just as I have made mistakes.  The doctor-patient relationship is shattered in my case.  Two entities become one, and one can’t be differentiated from the other.  Am I the patient or am I the doctor? 

At the end of the day, there was nothing that I could do, but to put my trust upon the Lord, and that He bring healing upon me, if He needed to use doctors to do it, then let it be.  I accept. 

After I placed myself on NPO (non per os – nothing by mouth), made plans of admission, serial abdominal examinations, informed my relatives of my condition, and after twenty-four hours, the pain was gone.  I returned to DAT (diet as tolerated).  At the back of my mind, the pain may return, so I have to be ready, anytime.